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Comparison of Intima-Media Thickness of the Carotid Artery and Cardiovascular Disease Risk Factors in Adults With Versus Without the Down Syndrome

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Adults with Down syndrome (DS) residing in large institutional settings possess low levels of atherosclerosis. The purpose of this study was to determine whether community-residing adults with DS possess less atherosclerosis than adults without DS. The second purpose was to examine the relation between cardiovascular disease risk factors and intima-media thickness (IMT), a measure of atherosclerosis, in patients with DS. B-mode images of the left common carotid artery were collected to assess IMT in 52 adults with DS and age-, gender-, and race-matched adults without DS (27 women, 25 men; mean age 42 ± 5 years). Total body fat, blood pressure, fasting lipid profiles, insulin, glucose, C-reactive protein, homocysteine, physical activity, and dietary intake were also assessed. Adults with DS possessed lower IMT (0.43 ± 0.07 vs 0.48 ± 0.09 mm, p <0.001), systolic blood pressure (116 ± 15 vs 125 ± 17 mm Hg, p <0.011), and diastolic blood pressure (59 ± 10 vs 73 ± 9 mm Hg, p <0.001) and higher C-reactive protein (0.58 ± 0.55 vs 0.30 ± 0.42 mg/dl, p <0.003), triglycerides (126.5 ± 55.2 vs 103.8 ± 53.2 mg/dl, p <0.048), and total body fat (37.8 ± 10.2% vs 32.4 ± 11.2%, p <0.002) than controls. Male gender (p <0.001) and physical activity (p = 0.020) were identified as predictors of IMT for adults with DS and fasting insulin (p <0.001), age (p <0.001), gender (p <0.001), fruit and vegetable intake (p = 0.001), low-density lipoprotein cholesterol (p = 0.004), and smoking (p = 0.023) for controls. In conclusion, community residing adults with DS may be protected against atherosclerosis despite elevated total body fat and elevated cardiovascular disease risk factors. Predictors of IMT differed for patients with DS compared to controls, which indicates that patients with DS possess a unique model of atherogenesis.

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Methods

We used a cross-sectional, descriptive, comparative study design to determine whether the IMT of adults with DS differed from that of adults without DS and to determine the relation between IMT and known CVD risk factors in adults with DS. Fifty-two adults with DS with mild to moderate MR aged 35 to 60 years participated in the study. Participants were recruited through each county's office of developmental disabilities services and area Arc offices of 1 midwestern state. Because of the

Results

The mean IMT of adults with DS was significantly lower than the mean IMT of the matched control group (Table 2). There were no differences in the cholesterol profiles, except that adults with DS had higher triglycerides than controls, while CRP and total body fat were also higher for adults with DS compared to the matched control group (Table 2). Systolic and diastolic blood pressure were significantly lower in adults with DS compared to the matched control group (Table 2). The adults with DS

Discussion

Similar to previous autopsy studies, the IMT of community-residing adults with DS was significantly lower than that of the age-, gender-, and race-matched control group of adults without DS.1, 2, 3 The IMT findings suggest that adults with DS who reside in community settings may continue to be protected against developing atherosclerosis. It is remarkable that adults with DS in the present study had reduced IMT despite possessing significantly higher triglycerides, CRP values, and total body

Acknowledgment

We would like to thank the participants and care providers for their participation and assistance in the research project. We would also like to thank Eric Williamson, MEd, for his assistance in coordinating the recruitment and assessment of the participants.

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This research was funded by the American Heart Association, Dallas, Texas, and supported in part by grant M01-RR00400 from the National Center for Research Resources, National Institutes of Health, Bethesda, Maryland.

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